25 September 2008


The second thing that I needed to talk about was the field trip I went on Saturday.  As it goes with these things, I was invited late on Thursday afternoon.  So, cancelling all my very important engagements, including a relay marathon run, a nice lunch with a colleague and yet another Hash I committed myself immediately.

Travelling to the small village of Sankhu, 45 minutes north of "the Du" in 2 taxis filled with equipment, two drivers and 8 people was a hair raising experience.  Remind me to post a photo of a taxi. At one stage I was rather concerned that we weren't going to make it up a particular hill, a concern made all the more worse by the taxi driver checking 3 or 4 times that the handbrake was not actually on.

As no one on this trip really knew who I was or what I was there for, I was treated with a kind sort of mild neglect.  In fact my purpose was to simply observe and understand the process of an eye screening camp with a view to reviewing their data collection processes at some stage in the future.

On our arrival, everyone split up and started setting up with equipment in various inexplicable places around the school we were based at.  Not entirely sure what to do with myself I watched on as all this was happening, pretending to busy myself by looking at a pretty run-of-the-mill piece of paper with nothing written on it.  There was a tap on my shoulder and a suggestion to "please come".  Thoroughly uncomfortable, I managed to ask (in Nepali) where it was were were going.  This small effort seemed to be enough to prove to the crew that I was an alright sort of chap, and not there to spy on them, for this broke the ice for the rest of the day.  If fact, that singular moment was more of an opening for hand-holding, belly-rubbing, and other inappropriate man touching than ever there was - at least in my experience. 

We were in fact off to "breakfast" (by which I mean morning tea) usually taken by the staff at Tilganga anywhere between 9 & 10 - with lunch to follow closely at 12).  I do love the breakfasts I get when I am with Nepali's.  For some reason the management at restaurants open in the mornings speak little English and are generally unhelpful when it comes to pointing at an item and the vain hope that you might get to eat it.  Some weird fried beans, a spicy kind of soup and some oil with a touch of flour and water dropped in it and we were back at the school.  

Before we even arrived in the gate, my colleagues had disappeared to their various stations and had started seeing patients that had been registered and were waiting for us to return from breakfast.  Before I had my wits about me, 5 people had already had their visual acuity measured and they were knocking them off at a rate of about 2 per minute.  There seemed to be a lot of shouting and a lot of confusion and a general excitment in the air.  

From the Visual Acuity station they were sent accross a field into the Exam room, where all the lights were off and there was no shouting or excitement but plenty of confusion.  In fact, it was eerily quiet.  Eventually the patients managed to work out (probably through some kind of devining method) that they were meant to walk to the other end of the room and sit down.  There a silent man shone a light in their eyes (to check for disease) and either gave them some cream and packed them off to the Refraction station or gave them some drops and told them to sit on the bench.  For those patiently waiting on the bench, perhaps 10 minutes later, the strange silent mnan would walk up, shine a light in their eyes and direct them to Counselling.  [I should point out here that 'strange silent man' is a very nice bloke who has been very friendly to me all week, and even called me over to see a cataract close up, it was really cool].

At Counselling, by torch light, a young ophthalmic assistant would schedule the patient a pre-op and operation date (within the next week), take their medical record off them, give them a referral slip and briefly (and I mean in 30-40 seconds) explain what happens during a cataract surgery).  

From there, they would go to refraction, and have their refraction measured.  I'm not entirely sure of the point of this, as usually a cataract makes you partially or totally blind in that eye, so having measurements taken for glasses seems a litte redundant.

Expecting to see 200-250 patients, and only getting to 115, we promptly packed up, hired a local bus and made the return trip inside 20 minutes.  We didn't have the hill that almost killed the taxi to thank for this but the insane lunatic maniac bus driver whose muscles were so massive the seams on his singlet were busted.  He drove that bus like we were in a 4x4 race to get onto Noah's Ark with the flood waters lapping at our ankles.  I believe he is probably part of the facebook group "if you can drive through it, do it".

My role, ultimately in all of this is to determine (through data collection and medical records) why some people don't show up at hospital following these screening camps.  And from my minute observations and highly accurate interpretation of the Nepali language, here is my assessment:
- cataract patients tend to be older than 65
- the regions we are visiting often have people living in them with no education
- the whole problem is that no body has any money (our taxi cost 550R), not exactly monopoly money to some people
- many people have been living with blindness for many years

How on earth are you going to handle someone telling them to show up at hospital tomorrow for some other stranger to stick lights, fluids and fingers into your eyes?  Why would I go all that way to have someone cut into my eye with a scalpel, in a procedure I don't understand.  "I was blind yesterday and got through the day, maybe I'll chance tomorrow too".  With all that yelling and confusion, I'm surprised some people knew which way to go to get home.

I'm not saying that the screening camp was not an amazing thing.  It truly was.  I understand that they need to be quick to get through 250 patients with only 7 staff and a few hours.  But I think just a little empathy, a little consideration could go a long way into making sure patients come along when you are telling them they have a disease that is easily curable, provided you allow hem to CUT A HOLE IN THEIR EYE!  


Amy xxoo said...

I can completely understand that Rob.People with little to no money, no understanding of whats going to happen to them ( including complications ) and who have been doing okay with the useful vision they do have - why would they bother showing up ?

I mean, i have patients coming into to the practice i manage here in a First World country who have the same atittude. " Yea, i know, but i've been doing okay for the last year - why not wait a bit longer ? ". I dont think some of them realise that cataracts can grow, irreversably, almost overnight : one day its slightly blurry but you can manage, next week you're blind....

Isa said...

Just wanted to say I'm still loving the blog, keep up the good work Rob! (And it sounds like you ARE actually doing some good work, so hooray for the AYAD program too!)

Dash said...

thanks for the comments, always good to know I'm not insane.

amy, you can still operate on it after that though right. At home, what scares me is that those peeople often think they can drive and do other such things...

I believe your blog is due for an update dear isa...tsk tsk. MORE PHOTOS! I really can't wait until we get to compare our stories at our debrief.